Nine patients with acute fulminant hepatic necrosis with stage 4 coma have been subjected to plasmapheresis with plasma exchange. Two emerged from coma only to die from pulmonary complications. Despite improving hepatic function and regeneration of hepatocytes, all patients died of extrahepatic complications. Postmortem studies of one patient (case 7), utilizing immunofluorescent tagging techniques, demonstrated Australia antigen (HAA) in all tissues studied, including liver, brain, heart, lung, ovary, spleen and kidney. Fulminant viral hepatitis is a systemic disease with multiple organ involvement. Therapy should be directed not only to the liver but should include measures designed to combat systemic effects of the
Lepore MJ, Stutman LJ, Bonanno CA, Conklin EF, Robilotti JG, McKenna PJ. Plasmapheresis With Plasma Exchange in Hepatic Coma: II. Fulminant Viral Hepatitis as a Systemic Disease. Arch Intern Med. 1972;129(6):900–907. doi:https://doi.org/10.1001/archinte.1972.00320060048004
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